Adding more staff members isn’t enough to improve quality of care and outcomes for people in nursing home facilities that have a lot of residents with dementia, according to a study out of University of California, Irvine. 

Staff members need training, an easy-to-navigate environment and stability to do that, according to a report out last month in Health Services Research.

Generally, adding more staff members improves outcomes for residents. But that’s a bit different when a facility has residents with dementia who need extra care given by people trained to care for them. More than 40% of people in nursing homes have Alzheimer’s disease, related dementia or cognitive impairment, according to the Alzheimer’s Association. As a result, they need extra physical care from staff who understand how to communicate with them.

“We wanted to understand the association of staffing hours with care quality and compare the health outcomes in nursing homes with high- and low-dementia populations,” Dana Mukamel, PhD, a study author and professor of medicine at UCI. “We found that registered nurses’ and certified nurse assistants’ staffing hours per resident-day were likely to improve outcomes for both high- and low-census dementia facilities but that simply increasing staff is not likely to be a solution.”

The team conducted analyses on nursing homes between 2017 and 2019 using data from various sources. The team examined staff hours per resident-day and dementia population percentage, controlling for other resident and facility characteristics. 

Registered nurses and certified nurse assistants were likely to see positive outcomes throughout most of the range of hours per resident-day for both high and low-census dementia facilities, though those facilities differed in most outcome rates at all staffing levels. Higher dementia facilities had worse average predicted antipsychotics and activities of daily living as functions of hours per resident-day were worse in higher dementia facilities. Independent movement and hospitalizations did not differ significantly. Emergency room visits and pressure sores were worse in lower dementia facilities. 

“Our findings highlight the fact that high-quality care involves not only increased staffing, but also specialized training in practices proven to be effective in managing the complexities of this condition, as well as providing a secure environment and maintaining staff consistency,” Mukamel said. “Further research is required to identify specific areas that can be targeted to pinpoint opportunities for improvement in both low- and high-dementia facilities.

Nursing homes are awaiting a final rule regarding the staffing mandate, which would increase nursing staff at facilities.